"Dental Care Is Not My Priority": A Descriptive Qualitative Study of Experiences and Support Needs for Oral Health Self-Care in Older Adults With Type 2 Diabetes.

Gap in Dental Care Can Lead to Diabetes, Other Disease Conditions

The aim of this study was to document perceptions of oral health of community-dwelling elderly people and how it had been affected through life. Twelve individuals (mean age 78.2 years) were gradually recruited to an interview study. The interviews were conducted as conversations, and the topics in a guide model were introduced only if they did not arise spontaneously. The interviews lasted 60-90 min and were tape-recorded and transcribed verbatim and analysed by the phenomenological-hermeneutic method. The interviews dealt with perceptions of growing old, life style, general health, former dental experiences, dental care in adult life, current oral health, general medical care, dental care, oral hygiene, dental hygienist care and the level of participation in treatment decisions. The interviewees were generally satisfied with their present oral health and often referred to their parents' oral problems as deterrents. Dental experiences from childhood, in association with the welfare state and personal financial security, were factors which influenced attitudes and perceptions of oral health and oral care. Although dental care was regarded as very expensive, it had been given priority over other expenses in adult life. The results confirm that the dental hygienist must take into account the importance of oral health to well being in old age and be aware that in elderly people, perception of personal oral health is multifactorial, influenced by life-long experience.

Valuing oral health: Accomplishments and challenges

Oral health status and perception of oral health of young Australian adults

To identify culturally related stressors that influence self-care in Chinese older adults with multiple chronic conditions. Effective self-care can improve health outcomes for chronic conditions, but implementing self-care is challenging. Individuals with multiple chronic conditions face even more self-care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self-care in multiple chronic conditions, the role of culture in generating stressors has been neglected. This paper reports on the qualitative component of a larger mixed-methods study. Two free-response items in a survey were used to identify culturally related stressors that influence self-care. This report adhered to the SRQR guideline checklist. Data were collected between January and April 2022. One hundred and thirty-eight free text responses asking participants to identify stressors that influenced their self-care effectiveness were analysed sequentially using deductive content analysis and thematic analysis. Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day-to-day self-care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self-care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions. Stressors that might influence self-care ability are important for nurses to assess in people with multiple chronic conditions. The design of self-care interventions should take a culturally tailored intergenerational family-centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes. What problem did the study address? Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self-care in Chinese older adults with MCCs is lacking. What were the main findings? Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Where and on whom will the research have an impact? The research will have an impact on guiding nurses' assessment of culturally relevant stressors' impact on self-care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self-care. This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist. During the member-checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences.

Older adults with serious illness are particularly vulnerable to oral disease due to worsened overall health, progressive functional loss and polypharmacy. Meanwhile, inability to communicate oral health needs, increased functional disability and psychological distress also hamper timely oral health care and lead to prolonged suffering and compromised quality of life. While many seriously-ill older adults with poor oral health receive no oral health care prior to death, unnecessary treatment is also common. In response to these issues, a new oral health care model is proposed to better address the oral health needs of older adults with serious illness. This model aims to promote comfort, maintain oral function and improve quality of life. End-of-life oral health trajectories and stage-appropriate oral health care strategies are also introduced to guide the care of these vulnerable individuals.

Improving health in the United States: Oral health is key to overall health

BackgroundIndigenous Australians suffer substantially poorer oral health than their non-Indigenous counterparts and new approaches are needed to address these disparities. Previous work in Port Augusta, South Australia, a regional town with a large Indigenous community, revealed associations between low oral health literacy scores and self-reported oral health outcomes. This study aims to determine if implementation of a functional, context-specific oral health literacy intervention improves oral health literacy-related outcomes measured by use of dental services, and assessment of oral health knowledge, oral health self-care and oral health- related self-efficacy.Methods/designThis is a randomised controlled trial (RCT) that utilises a delayed intervention design. Participants are Indigenous adults, aged 18 years and older, who plan to reside in Port Augusta or a nearby community for the next two years. The intervention group will receive the intervention from the outset of the study while the control group will be offered the intervention 12 months following their enrolment in the study. The intervention consists of a series of five culturally sensitive, oral health education workshops delivered over a 12 month period by Indigenous project officers. Workshops consist of presentations, hands-on activities, interactive displays, group discussions and role plays. The themes addressed in the workshops are underpinned by oral health literacy concepts, and incorporate oral health-related self-efficacy, oral health-related fatalism, oral health knowledge, access to dental care and rights and entitlements as a patient. Data will be collected through a self-report questionnaire at baseline, at 12 months and at 24 months. The primary outcome measure is oral health literacy. Secondary outcome measures include oral health knowledge, oral health self-care, use of dental services, oral health-related self-efficacy and oral health-related fatalism.DiscussionThis study uses a functional, context-specific oral health literacy intervention to improve oral health literacy-related outcomes amongst rural-dwelling Indigenous adults. Outcomes of this study will have implications for policy and planning by providing evidence for the effectiveness of such interventions as well as provide a model for working with Indigenous communities.

I read with great interest Kawakami et al.'s paper, “Examining the combined effects of social isolation and oral dysfunction on cognitive decline in community-dwelling older Japanese adults”.1 The research highlights a significant association between social isolation (SI) and oral dysfunction (OD), individually and in combination, with cognitive decline in older adults. Although the paper effectively presents these relationships, I propose an additional layer of understanding: that SI and OD are deeply intertwined, forming a self-perpetuating vicious cycle that accelerates cognitive decline. The study's conclusion regarding the combined factors of SI and OD, and their association with cognitive decline is particularly insightful.1 My opinion is that this association is strengthened by a bidirectional relationship between SI and OD, creating a feedback loop that intensifies their negative impact on cognitive function. This vicious cycle unfolds as follows: oral dysfunction often leads to social isolation. Challenges with eating, chewing and speaking, common manifestations of OD, can cause embarrassment and discomfort, leading to a reluctance to participate in social activities, especially those involving food or conversation. Consequently, individuals might withdraw, increasing SI and loneliness. This withdrawal reduces vital cognitive stimulation, directly contributing to cognitive decline. Specific issues in geriatric dentistry, such as significant tooth loss, complexities with dentures and dry mouth (xerostomia) often induced by polypharmacy, severely impact an older adults' confidence and ability to engage socially, further driving isolation.2 Conversely, SI can profoundly worsen oral dysfunction. A lack of social engagement can diminish an individual's motivation or access to maintain diligent oral hygiene, seek regular dental checkups or address emerging oral health issues.3 Without social support, self-care, including oral health, might be neglected. The psychological stress and potential depression associated with prolonged SI can also indirectly impact oral health by altering immune responses or reducing health-seeking behaviors.4 This deterioration in oral health then perpetuates the isolation, making social interaction even more challenging. Existing barriers to dental care in older adults, such as financial constraints, transportation difficulties, and limited access to geriatric dental specialists, are exacerbated by SI, as isolated individuals might lack the support networks necessary to overcome these hurdles.5 Negative attitudes and misconceptions regarding oral health in older adults, even among some healthcare professionals, further hinder access and motivation for care for those who are socially isolated. This interplay between SI and OD creates a powerful negative synergy, amplifying cognitive decline (Figure 1). Social isolation deprives the brain of crucial cognitive stimulation and increases psychosocial stress, both well-established contributors to cognitive impairment. Simultaneously, oral dysfunction can lead to malnutrition and chronic oral inflammation, which negatively impacts brain health.6 When these factors reinforce each other, cognitive reserve erodes faster, making individuals significantly more vulnerable to cognitive decline and dementia. The combined burden of increased oral disease risk (e.g. gum disease, tooth decay) and challenges in maintaining oral hygiene due to physical or cognitive impairments creates a cascade of health issues that collectively undermine cognitive resilience.6 Understanding this vicious cycle is critical for developing more effective and holistic interventions. Beyond promoting general social engagement and improving overall oral health, a comprehensive approach must consider several intervening factors. Integrated care models are essential, where dental professionals screen for SI and cognitive decline, and social workers understand oral health's impact on social participation. Psychological support is crucial to address distress and embarrassment. Nutritional counseling can mitigate cognitive risks from malnutrition. Community-based programs combining social activities with oral health education and accessible dental screenings offer dual benefits.7 Technology-assisted interventions, such as virtual platforms for social connection or digital reminders for oral hygiene, can support homebound older adults.8 Caregiver education on the interconnectedness of these factors is also vital. Crucially, targeted geriatric oral health initiatives are needed to directly confront specific challenges: effective xerostomia management, robust support for managing tooth loss and dentures, adaptive tools for oral hygiene despite limitations, and dismantling financial/transportation barriers to specialized dental care.9 Efforts must also shift negative attitudes and misconceptions about older adults' oral health. In conclusion, Kawakami et al.'s paper provides a vital foundation for understanding the combined impact of social isolation and oral dysfunction on cognitive decline. By recognizing the potential for a vicious cycle between these two factors, and by proactively addressing the specific challenges inherent in geriatric dentistry, we can move toward more comprehensive and impactful interventions. These integrated strategies will be instrumental in promoting healthier aging, and significantly mitigating the risk of cognitive impairment and dementia. No funding was received. The author declares no conflict of interest. All aspects of this work were carried out by the sole author. Data sharing is not applicable to this article, as no new data were created or analyzed in this study.

: The study aimed to determine the correlation among knowledge and attitude with the behavior of pregnant women in dental and oral health care during pregnancy. The research was analytic observational and in terms of time used crossectional approach. The population in this study were pregnant women at Narmada Community Health Center whereas the sample obtained by 34 people who came to check Antenatal Care (ANC) in June 2015 taken by accidental sampling technique. Data collection of knowledge, attitude and behavior variables used questionnaire and Statistical analysis was performed by using Chi Square test. The research finding indicated that from 34 respondents, 17 pregnant women (50%) had lack knowledge level about oral and dental health care during pregnancy. The attitude of pregnant women in dental and oral care during pregnancy was 73.5% (poor attitudes), and in terms of respondents’ behaviour was the same like respondents’ attitude by 73.5% (poor attitude). Therefore, it can be concluded that there was a significant correlation between knowledge with pregnant women behavior in dental and oral health care (P value = 0.013) and there was significant correlation between attitude with respondents behaviour in oral and dental care during pregnancy (P value = 0.004). Suggestion: It is expected for Health Care Institutions and health workers need to do an effort of sustainable counselling to communities, especially pregnant women about risk factors that can cause dental caries which can affect the health of both fetus and mother, increasing promotive efforts, for instance the improvement and maintenance of health and preventive efforts for communnities and pregnant women in order to have a good knowledge and attitude in maintaining oral an dental health care during pregnancy can be preserved and further enhanced, hence the sense of responsibility in terms of a behavior in the community or pregnant women concerning dental and oral health increases in line with knowledge improvement and developing attitudes.

Oral health trends for older Americans

Oral health care tips for caregivers

Effect of Implementing Dental Services in Israeli Psychiatric Hospitals on the Oral and Dental Health of Inpatients

Little is known about older persons' perceptions of oral health and oral health care. The purpose of this study was to explore the viewpoint of older adults' regarding their oral health care practices. A qualitative interpretive methodology was employed comprising three analytic levels: coding of data into concepts, analysis of concepts into themes, followed by an in-depth analysis of relationships within concepts and between themes. In-depth individual interviews were conducted with 19 participants aged 65 to 87 years. Older people's decision to access oral health care involves complex and personally meaningful strategies. A dental visit surfaces hopes and fears based on past and present experiences. Mouth and teeth are not merely objects of dental care; they represent a person's social and relational self. Age-related changes challenge the relational self as represented in societal ideal images of youth and perfection (the perfect smile). This study highlights older peoples' resilience and determination when faced with the dilemmas in accessing oral health care--it costs, personally as well as financially. Contrary to the assumption that older peoples' oral health status is related to neglect, rather for many, it is the result of the intersection of their history with technological advances. These findings challenge oral health care practitioners to be sensitive to the contexts affecting their older client's oral health care status. They do not 'just go' to the dentist; they bring with them their past dental experiences and their hopes for the future. It matters how one is treated at this vulnerable time.

To assess pregnant women's opinions on and perceptions of oral health and their relationship to oral hygiene and dental care practices. Questionnaire survey on perceived oral health, oral hygiene and utilization of dental services among 649 nulliparae attending for antenatal care at all public antenatal clinics in Adelaide, South Australia. Women rated their general health significantly better than their oral health (P<0.001) and attributed more importance to healthy teeth for their baby than for themselves (P<0.001). Only 35% had dental care during pregnancy; 35% had no dental visit for at least two years and 27% reported cost as a major deterrent. Eighteen percent had experienced gingival bleeding before pregnancy and 41% during pregnancy. Gingival bleeding outside pregnancy was clearly related to perceived oral health (P<0.001), but this was less so for bleeding during pregnancy. The latter was not related to age, level of education, employment, marital status, or smoking habits. Only 38% of women with gingival bleeding in pregnancy had a dental care visit in pregnancy and 28% considered their oral health as very good. Many pregnant women do not perceive gingival bleeding as indicating inflammatory disease and seek no professional help for it. Maternity care providers need to devote more attention to oral health in antenatal clinics and antenatal education.